Provider Demographics
NPI:1659038305
Name:SPRINGBERRY, MARI (PT)
Entity Type:Individual
Prefix:
First Name:MARI
Middle Name:
Last Name:SPRINGBERRY
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:MARI
Other - Middle Name:
Other - Last Name:GLASS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:402 91ST AVE NE
Mailing Address - Street 2:
Mailing Address - City:LAKE STEVENS
Mailing Address - State:WA
Mailing Address - Zip Code:98258-2530
Mailing Address - Country:US
Mailing Address - Phone:425-334-4071
Mailing Address - Fax:425-335-1894
Practice Address - Street 1:402 91ST AVE NE
Practice Address - Street 2:
Practice Address - City:LAKE STEVENS
Practice Address - State:WA
Practice Address - Zip Code:98258-2530
Practice Address - Country:US
Practice Address - Phone:425-334-4071
Practice Address - Fax:425-335-1894
Is Sole Proprietor?:No
Enumeration Date:2021-11-17
Last Update Date:2021-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPT611529432251P0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251P0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAPT61152943OtherSTATE LICENSE